A1C: does one size fit all?

摘要: Diabetes specialists almost uniformly nod their heads when I ask whether they see patients whose A1C results don't match blood glucose monitoring data. Providers used to attribute that unreliability of the monitors or patient records, but technological advances overcame those barriers. Some mismatches can be attributed inadequate temporal distribution sampling, and will easier define as continuous is more widely, a substantial number still remain unexplained. That has led controversy role remaining sources variation in routine whom there no obvious condition known influence values, i.e., hemoglobinopathy, red cell disorder, renal failure alter either mean age circulating cells hemoglobin chromatographic properties; rare drug modifies by variety mechanisms. Without such pathology, does fact remains suggest our standard goals for glycemic control do not fit all individuals with diabetes? Is it indeed valid equate become common? There one view proposes “high glycator–low glycator” hypothesis (1–9) explain how apparently equivalent could result differing values. The based on observation while most population given have within fairly narrow expected range, are subsets who consistently higher lower value. These due corresponding alterations relative rate intracellular glycation deglycation (red cell) turnover. How large problem this widespread clinical implications? Even if only 5% …